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Title: Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding.
Austin Authors: Robertson, Marcus ;Ng, Jonathan;Abu Shawish, Walid;Swaine, Adrian;Skardoon, Gillian;Huynh, Andrew;Deshpande, Sheetal;Low, Zi Yi ;Sievert, William;Angus, Peter W 
Affiliation: Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
Department of Gastroenterology, Monash Health, Clayton, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 4-Nov-2019 2019-11-04
Publication information: Digestive Endoscopy 2020; 32(5): 761-768
Abstract: Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48-month period. Patients were risk-stratified using AIMS65, Rockall, pre-endoscopy Rockall, Child-Pugh, Model for End-stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6-week mortality and inpatient rebleeding. Two hundred and twenty-three patients were included. Inpatient and 6-week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver-operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre-Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child-Pugh: 0.78). AIMS65 score ≥3 best defined high- and low-risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre-Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child-Pugh: 0.60). AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.
DOI: 10.1111/den.13577
ORCID: 0000-0002-8848-1771
PubMed URL: 31863515
Type: Journal Article
Subjects: AIMS65 score
portal hypertension
upper gastrointestinal bleeding
variceal bleeding
Appears in Collections:Journal articles

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